Induced Abortion in a Population Entitled to Free-of-Charge Long-Acting Reversible Contraception

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 132; no. 6; pp. 1453 - 1460
• Main Authors: Gyllenberg, Frida K, Saloranta, Tuire H, But, Anna, Gissler, Mika, Heikinheimo, Oskari
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.12.2018
• Subjects: Abortion, Induced - statistics & numerical data; Adolescent; Adult; Ambulatory Care Facilities - statistics & numerical data; Female; Finland; Humans; Long-Acting Reversible Contraception - economics; Long-Acting Reversible Contraception - statistics & numerical data; Medicin och hälsovetenskap; Pregnancy; Pregnancy, Unplanned; Primary Health Care - economics; Registries; Young Adult; Finland
• ISSN: 0029-7844; 1873-233X; 1873-233X
• DOI: 10.1097/AOG.0000000000002966

OBJECTIVE:To study the rate of induced abortion in a population in whom long-acting reversible contraceptive (LARC) methods are offered free of charge as part of primary health care services. METHODS:We conducted a register-based cohort study on females aged 15–44 years in the city of Vantaa, Finland. We assessed the rate of abortion among females entitled to LARC methods free of charge by survival analysis in four cohortsthose visiting public family planning clinics and initiating free-of-charge LARC methods during 2013–2014 (LARC cohort, n=2,035); those visiting public family planning clinics not choosing LARC methods (no LARC cohort, n=7,634); and three age-matched control participants for every LARC and no LARC participant from the general population not using the services (nonservice users, n=5,981 and 22,748). The patients were followed up by means of Finnish national registers until February 28, 2016. RESULTS:During the 78,500 woman-years accumulated, altogether 996 patients in Vantaa underwent an abortion (12.3 abortions/1,000 woman-years, 95% CI 11.6–13.1). Of these, 16 abortions occurred in the LARC cohort (3.9/1,000, 95% CI 2.4–6.0), 243 in the no LARC cohort (15.3/1,000, 95% CI 13.5–17.2), and 737 (12.6/1,000, 95% CI 11.7–13.5) among matched nonservice users. The adjusted abortion rate in the LARC cohort was 80% lower than in the no LARC cohort (risk ratio [RR] 0.20, 95% CI 0.11–0.32) and 74% lower than among their matched control participants (RR 0.26, 95% CI 0.15–0.43). In contrast, there was no difference in the abortion rate between the no LARC cohort and the control participants (adjusted RR 1.01, 95% CI 0.87–1.18). CONCLUSION:When providing a population with free-of-charge LARC methods, the abortion rate was markedly lower among patients initiating free-of-charge LARC compared with patients using the services but not initiating a LARC method. Programs of this kind could be of major importance in populations with high rates of unintended pregnancy.